RESPIRATORY REHABILITATION AND EXERCISE IN THE ELDERLY Over the years, respiratory function is altered negatively, by changes occurring in the external respiratory mechanics and senile involution of the lung tissues (parenchyma, bronchi, alveoli and pulmonary vessels). RESPIRATORY OPATOMECÁNICA
SENILE
senile involution determines important changes in external respiratory mechanics.
on the spine, is presented in a variable, a senile kyphosis, which will impact on the mobility and effectiveness of high and medium diameters toracocostal and indirectly abdominal mobility - diaphragm. Is due to dehydration and loss of disc thickness, especially in the anterior portion that determines a propulsion costoexternal forward elevation and costal horizontalization against their physiological tilt head - flow rate, thus increased posteroanterior diameter of the chest, inspiratory elevation to the position and transverse diameter decreased lung expansion driven by the increase of posteroanterior. The chest takes a stand inspiratory to a greater or lesser degree trend motivates the thoracic cage senile emphysema.
chondro joints - transverse and chondrosternal, they are becoming more rigid and eventually become the arch rib cage in a more or less stationary together with the alterations of spine and ribs are to reflect negatively on the exchange alveolar - capillary, ie on the overall respiratory function.
abdominal Mobility - diaphragmatic also altered, especially in the elderly has not been properly rehabilitated, he has made a sedentary or low exercise, watching a predominantly thoracic breathing and diaphragmatic breathing greatly reduced, adding almost always a little girdle muscular abdomen if not a pendulum that indirectly increases even more the inefficiency of diaphragmatic breathing.
LUNG CHANGES IN SENILE HISTOLOGIC The features senile bronchial lining epithelium atrophy, involution of the ciliary system of the mucous glands atrophy, hypotonia, and as a result of these changes, there is a decrease in ciliary motility, increased mucus and muscle hypotonia, leading all difficulties of cough by increasing the viscosity of mucus and as a result of efficacy in bronchial clearance mechanisms.
alveolar level degenerative elastosis there is a level of alveolar septa, combined with bronchial disorders will determine the central lobular emphysema. There are also changes of interest in the alveolar capillary diffusion.
The tissue hyperplasia observed that added to the overall increase in chips, determine loss of elasticity.
has been shown throughout life, inhaled particles pass into the alveolar Intersept, motivating a parenchymal stiffness factor.
Regarding the pulmonary vessels of the elderly, has been loss of the elastic system, increased fibrous tissue in the tunica media, leading all to a greater stiffness to be determined in the perfusion lung disorders, which influence the respiratory efficiency.
RESPIRATORY PHYSIOTHERAPY Definition.
physical processes are used to treat patients with a disability, illness, or injury to the respiratory system to achieve and maintain functional rehabilitation and prevent dysfunction. REMEMBER
anatomical - physiological Lungs, paired organs located in the thoracic cavity which held the breath.
In the adult human, each lung is between 25 and 30 cm long and has a more or less conical. The lungs are separated by a structure called the mediastinum, which contains the heart, trachea, esophagus and blood vessels. The lungs are covered by a protective membrane called the pleura pulmonary that is separated from the parietal pleura-like membrane located on the wall of the thoracic cavity by a flow lubricant. Inhaled air passes through the trachea, which is divided into two tubes called bronchi, each bronchus leads to a lung. In the lungs, the bronchi subdivide into bronchioles, which lead to alveolar ducts, they end up in some places called alveoli.
What is a nebulizer?
A nebulizer is a device that can deliver drugs in solution in the form of tiny aerosol particles to the tree tranqueo - bronchial.
operates through an air compressor, which nebulized medications that take the form of wet aerosol cloud is drawn into the patient to quickly take to the depths of our lungs, where they will achieve their therapeutic effect with minimal side effects in other organ systems.
Each nebulizer (excluding compressor), while in use, is personal and therefore should not be shared among different patients sick. If many patients require the use of a team, EVERYONE should have their own nebuliser mask.
POSTURAL DRAINAGE
Directions: Patients must remain immobile for long periods of time
Atelectasis
Accumulation of secretions
Decreased ventilation problems
restrictive or interstitial lobar emphysema
pleural drainage chest tube
Contraindications:
patient with cerebral edema Hydrocephalus
not put in the prone aPatients recent abdominal surgery, abdominal malformations, abdominal distension diaphragm compression. VIBRATION
Directions: Mobilize and thin secretions to larger airways mucus is
property liquefies special shaking movements
Contraindications:
Irritability during the procedure that compromises the patient's condition Absence of thick secretions
Interstitial Emphysema Pneumothorax
PERCUSSION
Directions: secretory phase (late) from hyaline membrane secretory
lobar pneumonia after 24 hours of antibiotics
Prevention of atelectasis post - extubation patients with copious secretions
Contraindications: No secretions
Interstitial emphysema, pulmonary hemorrhage
abscess, empyema or localized pneumonia treated with antibiotics before
Increased intracranial pressure intracranial hemorrhage
rib fractures or recent chest surgery and painful hemorrhagic diathesis
critical hypoxemia
Finish the procedure with Perform suctioning
new patient assessment, including: auscultation and identification of signs of respiratory distress
Let the patient in a comfortable position and monitored
Make notes on the sheet for nursing
immediately report your doctor about any intolerance during the procedure
Complications: accidental extubation, chest tube output, central venous catheter exit and / or arterial etc.
Increased intracranial pressure
Aspiration obstructive apnea, or by compromising oxygenation Hypoxemia
Bruising or skin lesions
Increased oxygen requirements
intrathoracic pressure increase risk of pneumothorax, rib fractures
liver hematoma or spleen
goal of treatment of respiratory therapy: Getting
a relaxation ventilation / perfusion effective physical media. Encourage the removal of respiratory secretions avoiding accumulation.
Position:
are trying to get through a particular position, improvement or the patient breathing pattern.
Percussion:
Action BOUT chest wall mechanics, transmitting a pulse of sound transmission, the effect is the mobilization of secretions in the bronchial tree. This has to be more durable in the more distal time is the accumulation of secretions from the main bronchial tree. The material used is: fingers, hands cupped position, electronic percussion (toothbrush, drum rotors, etc.) mechanical hammers (masks, flexible hollow utensils, etc..) and ultrasonic aerosols (for excitability of inhaled particles.)
Cough: physiological mechanism of choice for the expulsion of excess bronchial secretions. Sometimes the patient has a cough reflex abolished due to their condition, which does not require the stimulation, this is achieved, if the patient works, inviting him to perform deep inspirations without or works performed by external stimuli (saline, amongst others.).
Analgesia: Used mainly in cases where there is a postural muscle contraction of the chest wall due to thoracic interventions and / or abdominal. To administer this drug prescribed.
Aspiration of secretions from the bronchial tree:
is used for drainage of secretions from the main bronchial tree. We use specific probes attached to a vacuum system that generates a mechanical action of suction on the main bronchial tree. Bronchial washing
: Consisting of administering a liquid in the main bronchial tree (saline, "Mocofluid", etc.), To achieve fluidization of bronchial secretions.
RESPIRATORY PHYSIOTHERAPY
The primary purpose of chest physiotherapy in geriatrics, will be teaching the automatic diaphragm, supplemented by exercises against the rigid thoracic kyphosis senile and weak abdominal fascia.
1. DIAPHRAGMATIC AUTOMATION: to learn this technique, we first explain to the patient's "physiological respiratory form, ie, taking inspiration air through the nose for it to warm, moisten and clean due to the physiological function the mucosal lining of turbinates, which as we know clean the air of impurities, moistens and warms to body temperature. We will explain that with the nasal inspiration relax neck muscles involved with a bad arm lever, much consumption of oxygen by volume, with little effect on breathing. Finally, and immediately notices the patient, the nasal inspiration helps diaphragmatic mobilization.
The aspiration is for mouth, teaching him to control the air outlet for regulating the flow expiratory ventilation, and combining it with the elevation of the diaphragm.
inspiratory time on lar elation - expiratory first should be smooth and short, without force and the second soft, long and final l without ventilatory possibilities, but almost to the final contracting the abdominal, so that the diaphragm to work properly.
education should be started with rehabilitation of the posterior hemidiaphragm; for this exercise will put the old man supine on hard mattress or bed, legs bent to relax the abdominal and slightly apart, her head on the mat or a pillow hard and low as to be raised no auxiliary muscles relax and we will make it difficult for the reasons education pathomechanics.
not forget the environmental conditions humidity, temperature, ventilation and light to give comfort and relax the patient, began teaching exercise, bearing in mind that will draw inspiration soft "belly" and will get you gently expiration, the time loop with parted lips extending this phase as mentioned above. You should get a perfect synchronization between the expulsion of air, long, soft and long, and the simultaneous contraction of the abdominal fascia also smooth, without jerks and without straining your muscles. In this exercise is the basis for teaching diaphragmatic automation should keep in mind two aspects that may hinder or derail the rehabilitation plan, the first is a very common defect is that the patient on inspiration, ie "get the belly" arching the lumbar spine in the inspiration and explain that it makes little or no effective diaphragmatic breathing. The second aspect that can defeat this method is that the patient prolonged over the removal of CO-2 and tide.
With this exercise, we have retrained and put to maximum performance the hemidiaphragm can pass back and re-educate hemidiaphragms lateral decubitus position is right or left side, those raised in order to block breathing chest and lung recreational focus towards diaphragm; legs flexed to relax the abdominal fascia and the more we are re-educating the hemidiaphragm. The rehabilitation of the anterior hemidiaphragm performed by placing the patient the "four points" and prone to the exercise is very tiring to have to "raise the body" with the expansion of the anterior diaphragm. All these exercises are performed with the expiratory be reviewed as and when mastered, begin the road to automation of the diaphragm, which is not fully achieved until 6 months to perform these exercises daily.
2. EXERCISES FOR ABDOMINAL GIRDLE: Parallel to the teaching of abdominal exercises - diaphragmatic and using the same form expiratory precise teach exercises for toning the abdominal, that it will be the respiratory motor together with the diaphragm. These exercises will gradually with alternative lift both legs and then with both, bearing in mind the degree of muscle weakness and respiratory failure to perform them. Start by lifting a apierna, l demeanor is supine, knees bent and you are prompted to initiate a soft, deep inspiration, "pulling the belly" and exhale gently parted lips and simultaneously raise your leg down at the end of exhalation so that it always takes the lead breathing exercise and not vice versa. It is important with low back pain and not increase it, place the legs with a pillow in about 45 degrees elevation, because in this way will achieve the same effects, and will not work hiperlordosante, it would be very negative for senile column . If necessary complemented with elevation of both legs being very present as respiratory and hiperlordosante effect of exercise.
3. EXERCISES THORACO - BAGS: The thoracic cage, loses elasticity and becomes more rigid. Against this involution senile exercises will be aimed, it aims to double from keep it as a side elastic and other possible cause abdominal breathing - diaphragmatic thoracic supplemented in order to achieve harmonious breath rune in all three expansion diameters thoraco - abdominal breathing, while insisting that he is the removability diaphragmatic priority in retraining senile.
for teaching these exercises, we will begin to mirror, to explain the old man to teach simultaneously removability abdomino - diaphragmatic must gently move the chest, following the same form expiratory be caught in the early years of automation diaphragmatic will help with hands placed on both hemithorax, with fingers parallel to the ribs, leaving the hands loose inspiration sen to facilitate the expansion of low thoracic or tangentially to the skin by pressing on expiration and following the same movement in reverse Unlike the one who did the rib cage to expand.
Another simple exercise and good results, is the classic "cross arm" in inspiration, simultaneously pulling the chest and abdomen and gently exhaling while the arms are in front of the face, always directing the breath to exercise and not reverse. Finally, another exercise that unifies all previous and acts synchronously on the three diameters of lung expansion and abdominal belt is sitting back against the backrest, inspired by removing the breast and belly and exhale gently bending the stems holding the abdomen, following always the way to and teach respiratory priority breathing on exercise.
5. EXERCISES FOR THE SPINE: are very important to complete the plan of respiratory therapy in the elderly and are aimed at fighting against senile kyphosis, are an excellent global breathing exercise. A simple and effective exercise, patient standing back against the wall, raising the arm inspire salt while "sticks out his chest and stomach" in and out dropping them, the usual form is expiratory this breathing exercises and combined with the default global anti - dorsal kyphotic desired.
RETRAINING THE EFFORT: we separate the elderly who have cardiovascular disease - lung have a deficit of only physiological old age. In the first you can not do this retraining, they recommend do all the exercises mentioned above which will be very beneficial in chronic bronchitic etc ... giving hygiene advice on walking, very gentle exercises and dietary rules.
In the elderly "healthy", however, if you can, after ergometric study which determine maximum tolerated apotencia l and consequently the type of sport or work 'to start retraining. The method is as follows: in the gym teaching continue to keep the form small expiratory efforts, treadmill or ergometer so that the patient learns to maintain this breathing exercise and above all know, is by way of breathing, recover from the effort.
Once breathing has been taught in the recovery effort and we are in a position, to guide you in the proper exercise its energy potential, vocational preferences and possible "retraining labor "with the collaboration of psychologists, occupational therapist and social worker. BREATHING EXERCISES
As part of the treatment of respiratory diseases that occur in the elderly have the breathing exercises that are used in both prevention and when you start the disease and chronic processes and can be prescribed in the 3 levels of care.
These exercises help you breathe more easily, decreasing shortness of breath, with the ultimate aim of improving the quality of life. It is important that the patient and the family collaborate, and practice it at least 3 times a day.
BREATHING LIPS WITH SEMI - CLOSED
This exercise is performed 3 times a day, morning on rising, at noon before lunch, and at night before bedtime.
Guide for the procedure:
a) Sit comfortably in a chair or bed.
b) Breathe through your nose breathing in slowly and deeply, the mouth should be closed, having in mind 1-2, moving the stomach breathing out.
c) Throw the air through the mouth with lips semi - enclosed as whistling, having in mind 1-2-3-4, to dump all the air. Remember that when dropping the air (expiration) must be twice as long as when breathing (inspiration).
d) This exercise and must make at least 10 times. DIAPHRAGMATIC BREATHING
This exercise is performed 3 times a day, morning on rising, at noon before lunch, and at night before bedtime.
Guide for the procedure:
a) This exercise can be done sitting or lying preferably
b) Put right hand on stomach and left hand on the chest.
c) Breathe deeply and slowly through your nose, mouth closed mentally count 1-2, breathing the stomach has to move upwards which will move the right hand is on the stomach.
d) Discard the air through the mouth with lips semi - closed as whistling, having in mind 1-2-3-4, while the air boot of the lungs. With the hand that those holding the stomach muscles to push this out to remember that when dropping the air (expiration) must be twice as long as when breathing (inspiration).
e) The left hand is in the chest should not move.
f) This has to do exercises and at least 10 times. ASSISTED TOS
This exercise will help to cough and throw up phlegm or secretions. We will do especially in the morning, when secretions accumulate in the evening, or when you feel mucus and secretions.
Guide for the procedure:
a) Sit up straight in a chair, wearing loose clothing, no food on the mouth, have a handkerchief to cover your mouth when you cough.
b) Breathe in slowly through your nose with your mouth closed.
c) Throw the air with the lips semi - closed, slowly and everything that can be counted in the approximately 1-2-3-4m while the air boot, remember to throw the air (expiration) must be twice time when breathing (inspiration).
d) Breathe through your nose again making the stomach.
e) Tilting the nose again for making the stomach.
f) Lean forward slightly, put a monkey in the stomach and another to cover your mouth and cough 2 or 3 times.
EXERCISES ENERGY CONSERVATION
These exercises help reduce the sensation of breathlessness and will be useful in ADL as sitting and standing, swim, climb stairs, walking, grooming up to go shopping.
This exercise should be done every time you do an activity knows that it causes shortness of breath.
EXHALE DURING EXERCISE:
This technique is used when you need to perform ADLs such as sitting and standing, swim, climb stairs, walking, grooming up to go shopping.
a) Before starting the activity rune makes breathing slowly and deeply through nose with the mouth closed.
b) Throw the air through the mouth with lips semi - closed.
c) While the air boot to the activity was scheduled.
d) When the air buttons to stop and take another breath slowly and deeply through your nose.
e) After throwing the air with the lips semi - closed and continue the activity.
f) Remember to do this activity when throwing the air.
Tips to simplify the work:
a) Do things slowly.
b) Make slow, gentle movements.
c) To reduce the body's movements.
d) It uses more energy standing than sitting, therefore seeks to subtract sitting not to mention move every so often when you rest. Both extremes are not recommended.
e) Try rempujar objects instead of lifting, the casters are ideal for transporting objects.
f) In making a time-consuming to take 10 min break every hour.
g) Distribute the activities outside the home at different times of day.
GENERAL PLAN SUMMARY OF THE EDUCATION OF A RESPIRATORY PHYSICAL THERAPY IN THE ELDERLY
have been simple but effective exercises to achieve maximum benefit from the potential respiratory senile involution determined, and automation diaphragmatic, abdominal belt, chest , column retraining the effort. This method can be taught in groups of 8 to 10 patients and usually in about two weeks, on average, are able to do the exercises and in their domain.
In the early months will be controlled in order to avoid bad posture and can derail learning regardless of chest physiotherapy, make the drop, do not forget that teaches the exercises is easy, how difficult is the constancy performed daily.
Once discharged from the gym, it is recommended that you perform the exercises at least half an hour morning and night regardless of who performs the type of physical activity recommended and, above all, learn and practice the recovery effort, both in daily life activities in the exercise schedule.
Normally it takes about six months for an unconscious breathing as instructed. From this point, the old man learned to breathe physiologically, a wave will mannered yn subconscious.
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